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Massive subaponeurotic haematoma occurred in a baby after suture of bleeding scalp blood sampling stabs made before delivery. Eighteen hours after delivery blood samples showed marked prolongation of the prothrombin time. The condition was successfully treated with vitamin K(1) and blood transfusion.
Respiratory illness and infection was studied in the community of Tecumseh, Michigan, USA, during a six-year period. Acute illness was ascertained by making weekly telephone calls, and prevalent agents were identified by microbial isolation. Infection rates were determined serologically using blood specimens collected routinely at six monthly intervals from those reported to be ill. Illness rates were higher in the youngest children of families up to the age of three years than for the oldest children of the same ages. Above the age of three, the pattern was reversed. Among the adults, rates of illness were shown to relate not only to the presence, but also to the age of children in the home. Throughout this comparison, women were more likely to be ill than men in the same groups. Smoking in itself was not related to increased acute respiratory illnesses, but persons with symptoms of chronic bronchitis were found to have higher illness rates independently of whether they smoked.
Genetic factors may influence outcome from cardiac arrest. In Seattle, WA, paramedics collected blood specimens from patients who had suffered cardiac arrest outside of a medical institution (out of hospital cardiac arrest). We examined associations between apolipoprotein E (APOE) genotype and outcome in 134 who died "in the field", 131 who died in the hospital, 198 patients who were discharged from hospital alive, and 64 control subjects. APOE genotype was not significantly related to outcome, including being alive at and being independent by 3 months after the arrest. Specifically, having one or two alleles of APOE epsilon4 or having APOE epsilon3/epsilon3 was not related to outcome, even after controlling for age, sex, race, and initial rhythm. We failed to confirm previous studies and found no significant associations between APOE genotype and outcome from out of hospital cardiac arrest.
Two pregnant sows were fed on a basal diet consisting of equal amounts of ground barley and ground wheat with or without addition of L-lysine hydrochloride. Plasma amino acid and blood urea levels varied according to the time after feeding. Almost all the essential amino acids reached a maximum level after one hour and then declined at four hours after feeding. The results suggested that samples taken at between one and four hours after feeding were responsive to changes in dietary composition and could provide a measure to evaluate the amino acid pattern in relation to feeding. Both plasma amino acid and blood urea data suggested that lysine was the first limiting amino acid in the basal diet.
Percutaneous umbilical blood sampling has become an important tool in maternal-fetal medicine and allows direct access to fetal blood. In 52 patients, 100 successful consecutive blood sampling procedures were done for a variety of indications, including 20 intravascular intrauterine fetal transfusions for isoimmune disease. Indications, technique, and complications in this series of percutaneous umbilical blood sampling procedures are described.
A new protocol that makes it feasible to withdraw large volumes of whole blood from an individual rat within 1 h or less is described. This method involves the use of indwelling catheters for withdrawal of blood from the inferior vena cava with concurrent isovolemic replacement of whole blood into the superior vena cava. Simultaneity of the transfusion and withdrawal, strict equality of volumes, and a smooth exchange of blood are assured by the use of separate channels of the same multiple-channel peristaltic pump for withdrawal and replacement. Validation experiments using both anesthetized and unanesthetized rats indicate that several responses remain essentially undisturbed during large volume blood sampling; these parameters include blood pressure, heart rate, hematocrit, plasma hormones including insulin and glucagon, plasma glucose levels, and feeding behavior. Considerations of technical and physiological limitations of the protocol, including choice of catheters and catheter placement, pump, sampling parameters, and obtaining donor blood, are discussed.
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The present study evaluated a protocol for drawing large volumes of blood over an acute time frame in conscious cannulated rats with blood from cannulated donor rats simultaneously infused to maintain isovolemia. During time control (n = 6), three successive 1.5-ml blood samples were drawn at 10-min intervals with equal volumes of donor blood infused simultaneously. One milliliter of blood was drawn quickly and saved for analysis followed by an additional 3 ml of blood withdrawal to total a 15-ml/kg hemorrhage. Two subsequent 1.5-ml samples were replaced with autologous (hemorrhage) blood. During hypoxia inspired O2 was decreased to 10% after the first sample-transfusion. The sampling-transfusion protocol (time control) had no effect on blood pressure (MAP), hematocrit (Hct), blood gases, renin, or adrenocorticotropic hormone (ACTH). Hemorrhage resulted in a significant decrease in MAP, Hct, base excess, and arterial PCO2 and an increase in arterial PO2, renin activity, and ACTH. Ten percent O2 resulted in significant hypoxemia, respiratory alkalosis, and a small degree of hypotension at the 20-min sample with no change in renin and a moderate increase in ACTH. The consistency of the results with previous studies confirms the utility and efficiency of large sample-transfusion protocols for the study of blood gas and endocrine dynamics in conscious rats.
The effect of repetitive sampling on insulin sensitivity was studied in anesthetized rats. During glucose clamp studies, glucose disposal decreased from 9.3 +/- 0.9 (SE) to 6.5 +/- 1.1 mg.kg-1.min-1 (P less than 0.05), and hepatic glucose output (HGO) increased from 1.2 +/- 0.8 to 2.4 +/- 1.1 mg.kg-1.min-1 (P less than 0.05) after a cumulative blood loss of 9 ml/kg. After a loss of 15 ml/kg, HGO rose further to 4.7 +/- 1.6 mg.kg-1.min-1 (P less than 0.05). During repetitive sampling under identical conditions, plasma adrenocorticotropic hormone (ACTH) increased, despite simultaneous saline infusion, from 68 +/- 11 to 102 +/- 15 pg/ml (P less than 0.05) with a loss of 8 ml/kg, while plasma insulin increased from 39 +/- 7 to 124 +/- 20 mU/l (P less than 0.01) with a loss of 10 ml/kg. Thereafter, ACTH and insulin rose progressively. Plasma corticosterone closely followed the pattern of the ACTH response, indicating that the stress of cumulative blood loss had a significant effect on adrenal steroid production. Increases in ACTH were retarded by reduced volume loss and accelerated by increased loss. It is concluded that stress from blood loss greater than 7 ml/kg may be a source of error in the evaluation of glucose turnover and insulin sensitivity during clamp experiments in rats.
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To investigate an appropriate solute kinetics model for clinical application, we analyzed urea nitrogen (UN) and creatinine (Cr) kinetics by a variable-volume two-compartmental model (2CM) and a regional blood flow model (RBF) in 44 hemodialysis patients with varying proportions of first compartmental volume and regional volume (p(1)). Solute kinetics could not be solved in some of the patients with higher p(1) values, and there were more solution failures by the RBF than by the 2CM. The solute generation rate (g) and solute distribution volume in the dry state (V(D)) increased with increases in p(1) in both models, but there were some differences between the two models. When g was normalized by V(D), it became relatively constant, irrespective of the p(1) value or model used (0.133 +/- 0.029 mg/min/l by the 2CM and 0.132 +/- 0.029 mg/min/l by the RBF for UN; 0.0200 +/- 0.0049 mg/min/l by the 2CM and 0.0198 +/- 0.0048 mg/min/l by the RBF for Cr). The intercompartmental mass transfer coefficient (K(c); liters/min) calculated by the 2CM decreased as p(1) increased (K(c) = -1.77.p(1) + 1.16, p < 0.0001, R = 0.999 for UN; K(c) = -0.847.p(1) + 0.556, p < 0.0001, R = 1.000 for Cr). The systemic blood flow (Q(sys); liters/min) calculated by the RBF also decreased as p(1) increased (Q(sys) = -11.1.p(1) + 6.21, p < 0.0005, R = 1.000 for UN; Q(sys) = -5.22.p(1) + 2.90, p < 0.001, R = 0.999 for Cr). Since the RBF more frequently failed to solve the solute kinetics and since there was a difference in its Q(sys) values for UN and Cr, the 2CM was considered to be a superior model. When p(1) was extremely low, the 2CM could be transformed into a modified variable-volume one-compartment model (1CM) which presented a similar g/V(D) (0.133 +/- 0.029 for UN; 0.0200 +/- 0.0048 for Cr). This modified 1CM was considered to satisfy appropriate conditions for clinical application, since it is simpler than the 2CM and provides useful information on the dialysis dose.
OBJECTIVES: This study was undertaken to assess the feasibility, tolerance, haemodynamic and haematologic effects of an aggressive phlebotomy schedule for autologous blood donation (ABD) in adolescents undergoing major orthopaedic surgery. METHODS: Twenty adolescents were studied prospectively; 10 patients in group A donated 20% of the circulating blood volume on 2 occasions, whereas 10 patients in group B donated 10% on 4 occasions. RESULTS: The amount of blood donated, subjective tolerance, cardiovascular changes during the procedure and pre-operative haemoglobin level did not differ between the study groups (group A 111+/-16 vs. group B 106+/-10 g/l). The increase in erythropoietin was greater and occurred sooner in group A than in group B. CONCLUSION: In adolescents ABD is feasible with a reduced number of appointments as they demonstrate tolerance to phlebotomies with a volume which is double the standard per deposit.
Withdrawal and infusion of blood via umbilical catheters can affect cerebral blood flow in preterm infants. We compared the effects on cerebral perfusion of 3 ml/kg blood withdrawal and infusion via umbilical arterial (UAC) and venous (UVC) catheters in 16 infants < or =32 weeks gestation, age <24 h, on mechanical ventilation. Near infrared spectroscopy was used to monitor changes in cerebral oxy- and deoxyhemoglobin, total cerebral hemoglobin (an index of cerebral blood volume; CBV) and HbD (an index of cerebral intravascular oxygenation). In 10 infants the study was repeated 1 h after intravenous administration of 10 mg/kg ibuprofen as prophylaxis against PDA. Withdrawal and infusion via the UVC caused significant MABP and concordant HbD and CBV changes. Smaller modifications were seen following blood withdrawal and infusion via the UAC. Ibuprofen attenuated cerebral hemodynamic changes associated with withdrawal, but not infusion, from UAC and UVC.
OBJECTIVE: In intensive-care unit (ICU) patients it is common practice to sample blood from central venous lines (CVL). This study was designed to answer the question on how much blood has to be aspirated through the CVL before the actual blood sample is taken to get accurate laboratory findings. DESIGN AND SETTING: Simultaneous blood samples from a peripheral vein (intraindividual control) and 5-ml portions from a CVL up to 25 ml were analyzed. PATIENTS: 5 patients of an internal ICU participated in the study. RESULTS: For the analyzed 24 different parameters it could be shown that after aspirating 10 ml of blood, the results are comparable to analyses from peripheral vein samples. CONCLUSIONS: Although blood sampling from a CVL--after aspiration of 10 ml blood--results in correct laboratory analyses, this procedure leads to a greater amount of blood loss and, hence, cannot be recommended in long-term ICU treatment.
It is possible to determine alpha1-antitrypsin Pi types from serum obtained at necropsy. The Pi types were identical in 37 paired antemortem and postmortem samples. Blood transfusion in the 72 hours preceeding death may produce serum that cannot be typed. The frequency of the Pis allele was high in this study (0.074) and may reflect terminal alterations in alpha1-antitrypsin mobility and thus Pi typing, or a higher frequency in the population studied. The Pis allele was particularly frequent among Canadians with French names and Canadians born in Italy, Greece, and Portugal. The prevalence and severity of emphysema were not increased in PiA and Pis heterozygotes, but the groups studied were small and the variable, smoking, could not be adequately controlled. Studies of larger groups are recommended.